While the phrase may be new, the underlying science isn't. As DMCB readers are aware, it's one thing to transfer information to patients, it's another thing to transfer skills.

Dr. Coleman points out that a patient with diabetes, heart failure or asthma is not unlike a person just learning to drive. While some classroom work on how an internal combustion engine works is a good idea early-on in the process, it's not until the student takes "the wheel" of their glucometer, diuretic meds or peakflow meter that you can really know that they won't end up in a hospital (a.k.a. having an "avoidable admission").

Accordingly, individuals with chronic illnesses (and their layperson caregivers) need practice, rehearsal and role playing. They need to test the care plan and make sure it comports, to any degree possible, with the home environment and the skills of the involved individuals. Better to find out early about any obstacles, such as poor vision, low health literacy, cognitive impairment or low self-confidence.

Naturally, the traditional health system is ill-equipped to provide simulation learning experiences. There has to be dedicated space and the personnel who offer it to patients have to role-play, which can be very time consuming. Since each patient is ultimately unique with very different home circumstances, there is no one-size-fits-all approach

That being said, the DMCB suspects that as ACOs, integrated systems, provider networks, medical neighborhoods, managed care organizations and payers continue to evolve toward high value health systems, their hospital discharge planners, rehab-center case managers and transitions care managers will find that the "return on investment" from avoided re-hospitalizations, fewer unplanned ER visits and decreased redundant specialist visits will be more than enough to justify the cost.

And then there's the added bonus of the jargon that may warrant its own acronym of "SLE." The DMCB coyly suggests readers spring the term on an unsuspecting or clueless co-worker, boss, policymaker or doc who is all about "patient education."